Break it down for me Gillick Competence and Fraser Guidelines

[FemaleAndLearning]

Could we have a break it down for me style of thread on Gillick and Fraser? I see transactivists saying that because Starmer said in the interview with Mumsnet that he doesn't think children should be socially transitioned without consent of patents that this means he doesn't understand Gillick Competence or wants to get rid of it thus preventing under 16s accessing the contraceptive pill and abortions without their parents consent. But contraception seems to come under Fraser Guidelines not Gillick?

My understanding is that Gillick Competence is for medical procedures. The Cass Review cass.independent-review.uk/publications/interim-report/ says that social transitioning is not a neutral act and should occur under medical supervision (from memory). So is social transition a medical procedure? How does this relate to the Kiera Bell case where accusations of breaching Gillick Competence have also been made.

I found this by the NSPCC
learning.nspcc.org.uk/child-protection-system/gillick-competence-fraser-guidelines#article-top
But it doesn't give a lot of examples and given the case law around this would suggest this is not a clear cut piece of legislation.

It would be really useful to have a clear thread on this subject that can be referred to and used to back up discussions. Thank you.

It's worth remembering that trans activists have no interest in child safeguarding or wellbeing. Their prime interest in children is how they can be used to promote the ideology - the fact that this involves exploiting and harming children's bodies. their future fertility, future sexual relationships and physical health is of zero concern to trans extremists.

All laws and guidance should quite rightly be subject to challenge and thought. Those who work with children regularly discuss and draw conclusions about a child's ability to consent / confidentiality / levels of understanding / impact of special needs / impact of external influences / grooming etc in relation to health. These are people who have the best interests of the child at the heart of what they do, in contrast to flag wavers for queer theory.

The CQC recently updated their comparison of Gillick / Fraser which is quite helpful:

www.cqc.org.uk/guidance-providers/gps/gp-mythbuster-8-gillick-competency-fraser-guidelines

It's false equivalence.

Just as comparing lgb with T is.

Access to the pill is life saving as a child (under 18) isn't in the best situation medically or emotionally to have a baby. That's evidenced.

The evidence for social transition is not secure.

It's ridiculous to compare the situations.

Fraser and Gillick are essentially the same things, but the Fraser ruling was specifically referring to contraception whereas Gillick can be used more widely.

Essentially they say that if a young person (under 16) has capacity i.e. the understanding of a medical treatment and its consequences (and the consequences of alternative or no treatments as well) then they can consent to a medical treatment or procedure on their own behalf, without needing parental involvement. Victoria Gillick was unhappy about her daughter being prescribed contraception and took a case to the House of Lords but lost and thus the phrase Gillick Competence was established. Lord Fraser was one of those who made the ruling and set out specific guidance around prescribing contraception itself.

Interestingly up to the age of 18 a child refusing treatment can legally be overruled by their parents - e.g. for chemotherapy or other nasty things that a child may not want.

When it comes to medical transition I think a lot of people would (should) question whether it is realistic to expect children/young teens to be able to comprehend the pros and cons of such treatment especially given that actual research evidence is thin on the ground and it is irreversible, life-altering treatment.

The gillick principles is why Keira Bell lost her appeal. The other side successfully argued the judicial review had overstepped the mark in declaring 16 and 17 year olds can't be presumed to have capacity to consent.

I see transactivists saying that because Starmer said in the interview with Mumsnet that he doesn't think children should be socially transitioned without consent of patents that this means he doesn't understand Gillick Competence or wants to get rid of it thus preventing under 16s accessing the contraceptive pill and abortions without their parents consent.

The critical bit of information missing here is that Gillick competence is separately assessed for each treatment. From the CQC link:

If a child passes the Gillick test, he or she is considered ‘Gillick competent’ to consent to that medical treatment or intervention. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. Additionally, a child may have the capacity to consent to some treatments but not others. The understanding required for different interventions will vary, and capacity can also fluctuate such as in certain mental health conditions. Therefore each individual decision requires assessment of Gillick competence.

So a teenage girl might have Gillick competence to decide to take the contraceptive pill, but not have Gillick competence to decide to start on a path which will result in sterilisation.

@OldCrone is spot on. Gillick competence in one area of medical treatment does not mean a child can agree to everything. Particularly unevidenced strategies that are being pulled back across Europe.

The starting point is that the TRAs complaining on Twitter don't understand Gillick competence and want to create confusion about its principles (also see TRAs approach to the Equality Act etc). They seem to think it's about allowing any age of DC to decide about any medical treatment/procedure/pathway independently of their parents. It isn't.
Schools haven't helped because they have pushed a similar approach to vaccination consent. (If a parent refuses consent, they will ask DC for permission often without ascertaining if there is a medical reason why consent has been witheld and without establishing if that individual child is Gillick competent).

For certain groups this isn't about safeguarding but about pushing an argument that ever younger children have bodily autonmy and should be encouraged to seek out other 'adults' rather than family support. It sits so closely with all the mainstreaming paedophilia arguments that it's sometimes impossible to see the line. That isn't accidental imo.

The single biggest misconception, or deliberate conflation depending on your cynicism, by TRAs when it comes to Gillick competence is the notion that if you’re telling children they can’t consent to gender treatments you’re saying they can’t consent to anything else. It simply isn’t true. Gillick competence is applied to individual situations and circumstances, even within one treatment.

The idea that a child is Gillick competent for one thing, ergo is Gillick competent for everything is wrong: when someone is competent for everything that’s called being an adult.

A female child can understand contraception because they understand the implications of having a child, but not understand the implications of having fertility or breastfeeding options taken from them.

A child could equally understand partially about puberty blockers but not all. For example, a female child can understand that they will stop breast growth. That’s a fairly simple thing to understand. But that doesn’t mean they have capacity to understand all the implications of that and all the other implications that come with puberty blockers and progression onto the next step of the pathway. A male child could understand PBs will stop him getting hairy. But that doesn’t mean he understands that he will never experience erections or orgasm, because there is no frame of reference for him.

And one child might understand more than another. The question of Gillick competence relies on each individual child being tested on individual topics. This is where the flaw lies with gender treatments; gender-affirming ideologically driven doctors do not adequately test their patients as to their understanding and don’t let a lack of understanding of the realities of these treatments get in the way of administering them.

Which is why it needs to be taken out of their hands.

X posted with others!

Yes @OldCrone that's absolutely right. Medical capacity decisions are all specific to the choice being made at the time. We more often see it with patients with dementia - they may have capacity to choose what they wear or what they eat, but not to decide whether they need an operation.

Over 18s are assumed to be competent adults for everything unless there is reason to think they are not - and this can be temporary such as head trauma or delirium from a UTI, or long-standing such as learning disabilities or dementia. The latter should trigger a capacity assessment for every decision, though, not an assumption that they are not involved in decisions about their care at all.

Children are assumed to not have capacity and parental or best-interest (usually the same, but see other cases like Charlie Gard where this goes wrong) decisions are made on their behalf. It's the in-betweeners where the grey area lies.

Gillick is just a name for a capacity assessment really - it's only so-named because of the case that birthed it, so to speak.

A male child could understand PBs will stop him getting hairy. But that doesn’t mean he understands that he will never experience erections or orgasm, because there is no frame of reference for him.

This is why no child has the capacity to consent to these treatments. If they have never experienced sexual attraction/arousal or orgasm, how can they consent to never experiencing these things? There is no frame of reference, no understanding of what these aspects of adult life mean. Jazz Jennings was told that an orgasm was like a sneeze.

The posters on this thread have nailed it.

Men like Jolyon Maugham and Owen Jones weaponsing Gillick competence and female abortion/contraceptive rights as a way of propping up their own ideology is pretty grim.

It's not even that difficult to understand. If a child were able to consent to anything without parental knowledge, then there would be no need for the principle of Gillick competence in the first place, would there?

A few elements to be aware of (other posters please correct me if I am wrong on points or terminology. This is mostly tangential to my expertise):

The terms (gillick competence and Fraser guidelines) are principles in law based on previous court cases.

They are not legislation as in "the equality act".

This means they are not laws written down as in "section X of the equality act states". They are basically legal opinion that becomes settled law.

This means they are "settled" until another case comes along to test the principles and either changes the underlying principle or clarifies the boundaries of the opinion.

A current example from a different system but essentially this is what is happening in US with "roe v wade". While it stood as settled law, it was "the law" in US that individual states cannot make state laws that ban or restrict access to abortion. When a state went to the supreme court to test this, the current set of justices had a different opinion and said "we think states can make these decisions". That is why a big issue in US mid terms is "codifying" row v wade - putting it in to federal legislation so it is like equality act - section X of the abortion access act says all women can chose (or whatever)

All of this means that we need to be careful about how we describe and think about these principles. As a PP has said - Keira Bell case tested limits of gillick competence. One judge agreed with her case, on appeal another didn't.

You're absolutely right @How2Support these are medical principles based on case law. But they are very much established medical practice, they are what we teach in medical schools. The Mental Capacity Act doesn't cover children but it does set out the basis for establishing if someone has capacity to make a decision and it's very similar to the process for establishing Gillick competence.

This is an interesting read: www.capsticks.com/insights/gillick-competence-learning-from-bell-v-tavistock-and-portman

One judge agreed with her case, on appeal another didn't.

My understanding was that the first case found that children could not consent to the treatments but the appeal court found, not that children could consent, but that it was not for the courts to decide whether they could or not. That is up to the doctors working with the child. But doctors were reminded by the court that the correct recourse for children who later felt they had not had capacity to consent was for them to sue the doctors involved.

And the initial hearing clearly laid out all the elements needed for consideration when assessing consent such as the fact that puberty blockers should be considered the first step on a pathway that involves cross-sex hormones and all the repercussions that follow from that - infertility, sexual dysfunction etc. Previously the two treatments were considered separately so that children were considered perfectly able to consent to the 'reversible' puberty blockers without considering anything further.

No nine year old is Gillick competent.
www.dailymail.co.uk/news/article-11376781/Puberty-blockers-given-children-young-NINE-Scotlands-Tavistock-Centre.html

Not an expert, but would social transition in schools even come under the criteria of Gillick competence? Social transition is not the same as medical treatment and it doesn't involve doctors. It's about the child telling the school that it wants to change name and pronouns and be allowed to use the opposite-sex facilities. If the school goes along with this and doesn't tell the parents, then this is presumably covered by whatever legislation governs whether schools are obliged to pass on information about a child to its parents. I don't even know if such legislation exists.

It's about the child telling the school that it wants to change name and pronouns and be allowed to use the opposite-sex

And are the school not then obliged to inform all female pupils' parents that all changing facilities are now mixed sex?

The idea that teachers can use the principle of Gillick competence to allow children to socially transition in schools is clearly misguided. Gillick is an assessment undertaken on a case by case basis to children under the age of 16. Looking at the NSPCC information (quoted below) linked in the OP it indicates the process that one would need to go through for each child to assess their competency. You cannot make a blanket decision that it is OK for children of a particular age to socially transition (this was confirmed in the Bell case). The idea that teachers have the training, knowledge, expertise and time to undertake such an assessment is totally deluded.

Assessing Gillick competence

There is no set of defined questions to assess Gillick competency. Professionals need to consider several things when assessing a child's capacity to consent, including:

The child's age, maturity and mental capacity

Their understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact.

Their understanding of the risks, implications and consequences that may arise from their decision.

How well they understand any advice or information they have been given

Their understanding of any alternative options, if available.

Their ability to explain a rationale around their reasoning and decision making.

Remember that consent is not valid if a young person is being pressured or influenced by someone else.
[This is a massive risk in schools]

Children's capacity to consent may be affected by different factors, for example stress, mental health conditions and the complexities of the decision they are making. The same child may be considered Gillick competent to make one decision but not competent to make a different decision.

If you don't think a child is Gillick competent or there are inconsistencies in their understanding, you should seek consent from their parents or carers before proceeding.

I believe Gillick can be used to assess whether or not a child is mature enough to make their own decisions in general, not just in a medical context.

There is no lower age bracket for Gillick competence. A nine year old might be considered Gillick competent for a straight forward dental treatment but not for taking puberty blockers and cross sex hormones.

So, a child was assumed to be Gillick competent and a Doctor put them on a course of treatment. It later turned out there was a mental health condition which should have caught but wasn't. Or, the child didn't understand the repercussions of the treatment, loss of fertility for example. Or, any bad outcome that was foreseeable, but was poorly explained. Or, any number of similar scenarios.

What if the Doctors are acting on the best training given, but the training was flawed, say from ideological capture?

Would the Doctor still have liability and, if so, how far would that liability spread? The surgeons, further down the line, is their involvement just handwaved?

If I were a HCP, I would want nothing to do with any of this.

Interesting thread, thank you all.

Just to clarify, AFAIK no schools have actually administered Covid vax to a student against the wishes of their parents. This possibility was publicised when the child vax programme started, but it certainly didn't happen in my school and I have not heard of it happening anywhere.

Imagine the potential challenges to the school by enraged parents.

Of course that's a medical procedure, social transitioning isn't. We still await DfE guidance as to what schools can and cannot do regarding the latter.

That is what I'd like to know. I'd have thought that this comes under safeguarding guidelines, but not sure whether those guidelines are enshrined in law.